June 27, 2024 • 31 mins
Have you ever struggled with the balance between savoring life's journey and maintaining your health on the road? That's the tightrope we walk in our latest episode, where we share tales from our medical conference adventure in Cleveland, and the attendant challenges of eating post-bariatric surgery. Our conversation takes flight with the introduction of Bari Buddy, the AI assistant that's revolutionizing post-op life with reliable, guideline-based advice, a creation honed through over a hundred hours of meticulous programming. Tammie dishes out her wisdom on navigating airports and staying true to dietary needs without sacrificing the joy of travel.
When the road takes a turn towards the procedural, we've got you covered with the nitty-gritty of colonoscopy prep for the bariatric patient. It’s a must-listen for anyone facing the daunting prospect of a colonoscopy, offering practical tips on a liquid diet and debunking the 'pouch reset' myth with an emphasis on a holistic approach to weight regain. Through Tammie’s lens, each patient's journey is underscored as unique and deserving of tailored care, sidestepping the notion that additional surgery is the go-to solution for complex issues related to weight.
Closing out, our discussion pivots to challenge the healthcare industry's fixation on BMI and weight. We advocate for a focus on overall wellness and metabolic health, pondering the conundrum faced by patients and doctors alike when cultural standards and medical requirements clash. From the diversity in athletic physiques to the comparative recovery paths of different bariatric surgeries, we shed light on the multifaceted world of weight management. This episode is an exploration of the many layers of obesity and body standards, offering insights and empathy to anyone affected by these pervasive issues. Join us for a heart-to-heart on the transformative potential of bariatric surgery, set against the intricate tapestry of societal, genetic, and psychological factors that shape our health and self-image.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics Podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Maria, you've been like MIA fora solid three months.
It is so hard to get time withyou.
I'm so happy to see your face.
Speaker 2 (00:35):
We just spent the whole weekend together pretty
much in Cleveland, which wasfantastic.
We were there for a conferenceand learned a ton about this
kind of surgery reflux surgery,all kinds of things.
It was a blast.
Speaker 1 (00:45):
Yeah, it was, so I should say yes, I have seen you,
just not on here, so it's likebrand new all over again.
That's right.
Speaker 2 (00:53):
And we've been working on a podcast.
We also created a chat GPT forour people called Berry Buddy,
which is like an AI assistantfor people who have gone through
bariatric surgery, and we'vetrialed it and tested it and
initially did not work, but nowit's working a little better.
Speaker 1 (01:09):
So, berrybuddy, try that out.
Yes, berrybuddy, chat GPT, yes,and it is nice.
I have gone on Facebook groupsfor bariatric surgery and
inputted questions off thatFacebook page into there and it
comes up with great answers.
So, instead of people usingthose Facebook groups as a quote
, unquote doctor, can I have anavocado one month post-op?
Everybody's going to have adifferent answer where this chat
(01:30):
GPT will give you a good, solidanswer that probably all
providers will agree with.
Speaker 2 (01:37):
Yeah, and we try to make it pretty generalized.
But it all comes fromguidelines and really good
research papers and our ownprogram materials and I spent
probably over a hundred hourstotal training this thing and
making sure it worked right andmaking sure it's not giving
people crazy answers.
That's not to say it's notperfect or that it is perfect.
It is not perfect.
However, it's probably a verygood general use tool so we can
(01:58):
create a, put a link up for that.
But if people want to give thata shot, definitely go for it.
It is free-ish Technically.
It's behind the paywall forchat GPT.
I can't change that at themoment.
Speaker 1 (02:09):
But as soon as I can, I promise you I will.
It's worth the $20 in myopinion, but that's just me.
Speaker 2 (02:15):
Yeah, that's true, and then money does not come to
us, it goes directly to OpenAI,so we don't make a single penny
from that at the moment.
Speaker 1 (02:25):
All right Throughout the past three months.
I keep coming up with questionsthat I want to ask you, and I
feel like our last question, orQ&A, went really well and it was
really informative.
Speaker 2 (02:31):
Yeah, where do you want to start?
And you can Q&A me too.
Speaker 1 (02:35):
whatever you want, oh yeah.
Speaker 2 (02:36):
Oh, 100% that's going to happen.
So actually let's go Q&A youfirst.
So you've been traveling somefor conferences.
We've gone to two so far thisyear and there's more coming up.
How do you deal with a changein your routine and stay on
track when you're traveling?
Speaker 1 (02:51):
Do the best I possibly can, I will say that
airports do have good, prettygood options.
You can almost always find somekind of grilled chicken.
Honestly, we found sushi, whichwas so good.
Yeah so good, there's watereverywhere, as long as you can
afford a $7 bottle of water, butthey have the water fountains.
So really just being in themindset of eating healthy,
(03:13):
keeping your fluids up, Becauseif you go sometimes this past
time I was flying I flew almosta half a day.
It was so bad.
It was like eight hours and soif I went that whole eight hours
without drinking anything, Iwould come home and feel like
I'm hungover.
So really being mindful andbeing strict with yourself of I
need to eat and I need to drink,but that's not to say you need
(03:35):
to be perfect.
I wasn't perfect, by any means,and I had a bag of combos
because, honestly, I needed acarb and I couldn't really find
any great carbs right in thatmoment.
So I had some combos.
Did I eat the whole bag?
No, but what?
Speaker 2 (03:52):
kind of quantity of combos did you have again?
Speaker 1 (03:54):
honestly, I would say a cup no, a bag you're done,
I'm sorry, I can't.
Speaker 2 (04:03):
We're both like we both and people from northern
iowa or parts of iowa just soundlike minnesotans and you're
from wisconsin, technically didI say it, did I say beg?
Of course you said big.
Speaker 1 (04:14):
Yes, you said big anyway, so I beg you to continue
no, but just making sure thatyou are eating and just because
you may not have the greatestoptions, to not eat, because
that's going to put you in awhole different world of hurt.
Speaker 2 (04:29):
That's very true.
Yeah, that's very true.
I love that because youbasically said be strict with
yourself, but strict where itcounts, if that makes sense,
because when you're travelingyour routine is going to be off
anyway.
I get super dehydrated when Itravel too, because you're just
more active.
Because you don't drink.
I also don't drink water, so,no, you got to drink.
But also be permissive withyourself.
If what?
(04:49):
If all the food around you isnot healthy, that doesn't mean
you don't eat, or that doesn'tmean you don't you don't take
some diets and take some things.
But yeah, you're right, I'vebeen impressed, actually, over
the past year.
I feel like a lot of optionseven in hotels have gotten
better.
They usually have some optionsdownstairs that you can grab,
and even options in coffee shopshave gotten better where you
can grab like a fruit bar ornuts or something like that.
(05:10):
So it really is getting better.
Speaker 1 (05:12):
But that doesn't mean that you just have to be a
saint and not partake when youyeah, especially when you travel
, because you have introduced meto so many foods that might not
be right in our bariatric bookof what I should eat, but I'm
going to eat it because I don'thave it all the time.
Speaker 2 (05:27):
Right and you're right, and we don't really talk
about how many things you caneat, and honestly, especially
from other cultures, because alot of other cultures have
totally different carbs andproteins and fats that they eat
and in different combinations,and sometimes it's healthier
than the standard American diet.
A lot of times it is.
Speaker 1 (05:49):
So getting creative and thinking outside the box
with what you're trying, that'ssuper, that's true, absolutely
Okay.
So I have a question for you,and I've had it come up when
during our program, but I'vealso actually seen it on their
Facebook pages, and it'ssomething that I think we can
talk almost more about later.
But a little quick how do youdo a colonoscopy prep when?
Speaker 2 (06:03):
you have bariatric surgery, cause you got to drink
all that in a short amount oftime.
Speaker 1 (06:08):
They're normal prep.
How do?
Speaker 2 (06:09):
you do that?
It's a great question.
Actually, I didn't.
We didn't have a standard wayof teaching patients how to do
this, and so we didn't have anymaterials in our program.
So when you brought this up acouple of months ago for our
chat GPT for Berry Buddy Iactually looked and I surveyed
some other surgeons that do thisand actually a lot of people
basically said no changes, whichI don't necessarily agree with
(06:31):
that, because I don't think thatyou can especially if you're
doing like a go lightly which isreally a go strongly but go
lightly prep like two gallons ofliquid that you're supposed to
do, and even if you're doing ina split fashion, where you're
doing like part of it one time,another part of another time,
you still probably shouldn't bedrinking more than about eight
ounces an hour, no matter what,as a bariatric patient.
Speaker 1 (06:52):
That just sounds painful Exactly.
Speaker 2 (06:55):
Think of when you were post-op and when you were
doing one ounce every 15 minutes.
You can probably do more thanan ounce every 15 minutes, but I
really wouldn't do more thanthree or four ounces every 15
minutes, because the other thingis all of that.
There it's more important toget the liquid in than how fast
you get it in.
In coming up with a combined, Ilooked at a lot of resources
(07:15):
for this and the consensus seemsto be start earlier and do the
best you can and do the best youcan.
Yeah, so over the two daysbefore your colonoscopy is when
I would recommend switching toliquids, as opposed to staying
on solids for the two days priorand then just being on liquids
the day before.
So I would do two days ofliquids and then start your prep
(07:36):
, whatever it may be.
Some places do Miralax,gatorade, some places still do
Golightly or Suprep or otherthings.
Just space it out over a day asopposed to over 12 hours, and
then really take thoserestrictions of liquids clear
liquids especially seriously,because your body's going to
have a little bit longer of atime processing things and a
little bit longer gettingthrough, and it's wiser for you
(07:58):
to start earlier.
Speaker 1 (07:59):
But this has me thinking of shouldn't there
almost be a separate type ofprep, because we don't eat as
much as most people do, so wedon't have as much to get
through our systems, right?
Speaker 2 (08:12):
I wouldn't say that's the case because a lot of why a
lot of people actually haveslower transit times after
surgery.
So some people definitelybecause of the malabsorption,
especially if you have a dutialswitch or bypass.
Sometimes your transit timesare faster, but sometimes
they're not.
So actually constipation is thebigger issue for people after
bariatric surgery, oftentimesagain because you're still
(08:33):
struggling with getting enoughfiber and getting enough liquids
in.
So transit times all in all areabout the same as they are
before surgery, just fordifferent reasons.
So my main takeaway here isplease start at least a day
earlier than you normally wouldwith your prep.
That's going to make sure thatyour chances of having to do it
all over again are less and thateverything's cleaned out, which
means that you get a real,really good colonoscopy.
(08:55):
And I do not recommend Cologuard, which is the test that you do
without the colonoscopy insteadof the right and like you can.
If you really just arecompletely grossed out by the
idea of a colonoscopy or justit's.
If the choice is no, nocolonoscopy at all or Cologuard,
then do Cologuard.
But even for my own family Ihave recommended against
Cologuard because it just doesnot detect as much early stage
(09:17):
colon cancer or pre-colon cancerrisk by any means as a real
colonoscopy does.
So I personally am not a hugefan of Cologuard.
For that reason, just throwingmy two cents in there.
Speaker 1 (09:27):
Absolutely.
Now, what do you think about apouch?
Quote unquote.
I am quote unquote, quotinghere a pouch reset.
I hear this all the time ofpatients like I'm doing poorly,
I'm gaining weight, and peopleare like, do a pouch reset, go
back to liquids and work yourway through the purees.
Yeah, what are?
(09:48):
Your thoughts on that.
Speaker 2 (09:49):
Yeah, so technically, yeah, technically we actually
had a whole panel on this atthis SAGES, the conference that
we went to over the weekend, andI was actually one of the
speakers on how to use your teamto combat weight regain after
surgery.
So this is a topic really nearand dear to me.
But the idea is there's no suchthing as a pouch reset per se.
Technically, if you've had asleeve some people do sleeve
(10:10):
resizing surgeries and if youhave had a gastric bypass which
does have a stomach pouch to it,there is a chance that the
pouch was made too big or thatthe opening between the stomach
and the small intestine hasbecome bigger over time.
That does happen.
We don't have a lot of evidencethat sleeves stretch out.
So if you started with a bigsleeve, if the surgery was done
(10:31):
in a way that it left a lot oftissue there, then you're going
to have a big sleeve and it'sprobably not going to work as
well as a smaller sleeve.
And it's the same thing with apouch.
If the pouch was big to beginwith, you're going to not have
as much malabsorption and asmuch metabolic change.
So your chances of weightregain down the road are higher
and your chances of not reallylosing the weight or having that
much change to your metabolismto begin with are higher too.
(10:52):
There are some surgeries thatcan be done to revise these
things.
That's typically not the firststep, though they're starting to
be right.
So, again, it's always a goodidea to reassess your lifestyle
in general.
Think that you're overeating.
If you think you're overeatingcertain things, if you think
you're not drinking enough, ifyou're thinking you're not
getting enough exercise youprobably aren't it's a good idea
(11:15):
to take a look at the thingsthat you can address and fix in
your lifestyle.
I will always say it's a goodidea to also think about your
mental health and make sure thatyou're not overstressed, that
you're in a good place, whetherthat means engaging with family,
friends or a professional orall of the above.
Those are good things to do.
Same thing with a dietician.
It's oftentimes helpful to havea third party take a look at
(11:35):
things, and not just yourfriends and family or yourself
when it comes to reality as towhat we're eating myself
included sometimes.
So that's a good idea.
Chatting with your bariatricprogram is a good idea if you're
having issues with weightregain, especially Some weight
regain is insignificant and itdoes mean something and some
doesn't.
So, we don't really treat all ofit the same way and it's not
(11:57):
like it's a straight shoot tosurgery for anyone, so that's a
meandering answer, but that'sbecause it's a meandering issue.
Speaker 1 (12:04):
Now you said reevaluate what you're eating.
So this kind of has a questionfor me how come I can only eat
six ounces of chicken breast?
But I could, if I wanted to andif I really felt like it, I
could almost eat a whole, half apizza.
I even told you the other daywhen we were eating sushi I'm
(12:24):
like wow, that little amount ofseaweed and California roll or
whatever we ate, filled me up somuch and it was such a little
amount of food.
But I technically, if I reallywanted to, could eat a whole lot
more in size of pizza.
Speaker 2 (12:38):
Oh, yeah, absolutely so.
There was actually one of thespeakers also at this conference
, when we were talking aboutweight regain, put up a couple
of charts that showed all of thedifferent hormones and all of
the different molecules that areinteracting in the body between
the stomach and the intestineand the brain and other body
parts, and there's like hundredsof them.
So I absolutely will not try torecreate this complex drawing
(12:59):
for anyone on a podcast.
That would be pretty ridiculous.
But the idea is that differentkinds of foods are processed
differently by our bodies, evenby the stomach as they hit the
stomach, even how our hunger andhow our desire for food, our
satiety when we feel full, isaffected by the food we eat and
if there's protein in it, ifthere's fiber in it, typically,
(13:21):
or even fat.
Actually, fat also typicallytriggers the feeling of fullness
faster than carbohydrates do.
And there's certain kinds ofcarbohydrates that trigger
faster than others, which is whyliquid calories typically, you
don't really feel full fromliquid calories, but you do feel
full from solid food, yeah, andso some of its physical, some
(13:45):
of its truly okay chicken kindof stays put more than like soda
or juice or something, or aprotein drink even, but if you
actually have certain proteins,and it's specifically some
proteins more than others, andsome kinds of fats more than
others, and insoluble fiber morethan soluble fiber, anyway, so
we can get into very specificthings in another episode, which
(14:07):
you probably should, but itabsolutely does matter what
you're eating, because you willfeel fuller faster if you're
eating things that have proteinand have fiber in them.
That does not mean, however,you should just be eating like
chopped chicken or something forthe rest of your life, and that
being the only thing, but thatis one reason why, when we talk
about eating snacks and food ingeneral, it's a good idea to eat
(14:27):
combinations of food ratherthan just one thing at a time.
Speaker 1 (14:32):
What if I came into your office and I said I don't
want to know what I weigh?
Yeah, I tell you all the timethat I'm honestly really not on
the scale a whole lot becauseand actually one of your panels
was talking about this andactually debating this BMI
target we should be at and oneof them was like I don't care
about a BMI target If my patientis a BMI of 38, let's say 40,
(14:57):
it feels fantastic.
I'm not going to choose thatBMI.
What if I came into your officeand, maria, I don't want to
know what I weigh?
Speaker 2 (15:06):
Yeah, absolutely.
We've actually had that Firstof all.
We've had that scenario.
So I can tell you 100% what Ihave done is said okay, no
problem, because I agree.
I think we have this obsessionwith BMI and weight in this
industry because it's the onething we can measure easily and
it's a vital technically, it's avital sign and, technically,
like we can measure it even athome with your weight, with your
scale and stuff, so pretty easyto measure.
(15:28):
That doesn't mean, it meansanything and I think that's
exactly what it was.
Actually Dr Teresa Lemasters,who's the recent president of
ASMBS, one of our bigorganizations and also just an
incredible powerhouse here inIowa, in Des Moines, who was
specifically talking about how,while BMI is an easy indicator
and it's something that we clingon to, it's not that useful and
probably in the next 10 yearsor so, there's even now a really
(15:51):
big push to move away from BMIand talk much more about
function, talk much more aboutwhat are our goals, what are our
metabolic issues that are goingon here.
Does this patient have diabetes?
Did their diabetes come back?
How bad is their diabetes?
What about their blood pressure?
What about other issues likefertility?
So I agree 100% that weighthere.
We oftentimes, and the problemis is, because it is a number
(16:13):
and because it is a, like, aneasy thing to measure, we not
just providers, not justsurgeons and coordinators and
stuff get get hung up on thissometimes, but it's used to
punish people.
I think sometimes to in thesense that with you, yeah, and I
think when we're talking again,like morality just doesn't have
any role in this field, orreally any healthcare field.
(16:34):
I think so when we're trying toprovide people care that
supports their goals and makespeople healthier, we should be
finding ways to enable that, notto make people feel bad about
it, and especially like you as aprovider, especially after
surgery, especially after thatlike one three month follow up.
Speaker 1 (16:51):
You only see six months and then you see a year.
Look, you don't know if, okay,I was 175 the last time but now
I'm 190.
But that might look different.
I might be way more in fit thannow because muscle does weigh
more than fat.
So how would you handle?
Because, as a provider,documenting, I think you do need
a weight.
And I think as a.
(17:12):
To be able to help your patient, you do need a weight.
How would you just ask themnicely to get on the scale but
turn around or like how?
Speaker 2 (17:21):
No, it depends.
It depends if actually we doneed that weight.
So different insurance policiesneed different things before
surgery, After surgery.
I don't really know of anyinsurance policy that requires
weight measurement becausenothing really depends on that,
so I don't.
The only consideration there iswhat is required by insurance.
And again, we use BMI and we useweight because it's easy to
(17:42):
bill for, it's easy to submit,requesting a prior authorization
or a billing code or somethinglike that.
Not because it's necessarilythe best measure of health.
Definitely it's not.
And it's not the best measureof success or goal achieving or
anything like that.
And I know personally Ifluctuate about 20, 30 pounds in
my life as an adult, andsometimes at my higher weight is
(18:04):
when I'm the most fit and at mylower weights is when I'm the
least fit.
And that extends massively toeveryone else on the planet too
and some of the some Olympiclevel athletes.
Actually there are quite a fewOlympic level athletes whose
BMIs are over 35.
So while they would qualify forbariatric surgery, that would
absolutely not be theappropriate choice for them, Nor
(18:26):
would any medical interventionbe appropriate for their weight
if they're achieving so muchfunctionally.
Yeah, I'm glad that there's areassessment of BMI and weight.
I don't think that's going tohappen overnight, so it depends
on what it's needed for.
If it's really neededdocumentation and we need to use
it to get to surgery, thenthat's a discussion, a
one-on-one discussion with aperson and to say, hey, we need
(18:46):
this for documentation and howimportant is it for you to get
to surgery?
Because we have to have it forgetting there.
But if it's not required andthe person doesn't want to do it
and it's not making adifference to their function,
then I agree.
Speaker 1 (19:04):
Yeah, absolutely.
So we talked about this onetime because we went and saw one
of our patients that just had abypass and I'm like she looks
like nothing even happened toher and I'm like I was over
there dying.
And you actually said bypassesare easier to heal from than
speeds.
Speaker 2 (19:17):
Yeah, okay.
So this is, I would say,immediate post-op.
It's not necessarily long-term,yeah, and it still depends on
how you do it.
But the thing is, when you'remaking a sleeve, what you're
doing is you're turning a bigreservoir, think a dam, like
before that wow, I'm really notan engineer, am I?
(19:39):
You're turning a lake, let's say, into a stream, and so the
effect of that is immediatelyonce you start drinking and
eating afterwards you reallyfeel the difference because you
still have a muscle right afteryour stomach called the pylorus,
that prevents things fromemptying or dumping into the
small intestine and moving on.
That is not there anymore aftera bypass.
(20:00):
That pylorus is bypassed partof the deep, the area that's not
part of the what's seeing foodor drink anymore.
So immediately afterwards youactually don't feel that kind of
resistance and that kind offullness and bloating that a lot
of people do feel after asleeve.
That's not to say that nobodyfeels that after a bypass, right
, certainly some people do, forthe the most part, but fewer,
(20:24):
and it's somewhat anecdotal, butactually there is some
literature on this too, thatit's actually easier to
discharge patients the day ofsurgery after a bypass, from a
symptom standpoint, or the nextday after a surgery that's a
bypass than it is after a sleeve, because about something like
80% of people who have a sleevestill will have some nausea into
post-op day one whereas thebypass is less than half.
(20:47):
So there's a big difference.
Yeah, based on that feeling ofoh, we've gone from a big space
to a little space that still hassome back pressure, versus in a
bypass, you're going from a bigspace to a little space, but
you don't have the back pressureanymore, because things are
immediately emptying from thestomach into the small intestine
.
Speaker 1 (21:02):
That makes sense.
Now, if you were, if youstruggled with weight or if
someone very close to youstruggled with weight, being a
bariatric surgeon, would youhave bariatric surgery or would
you recommend it to your family?
Speaker 2 (21:18):
Oh heck, yes, yeah, and I maybe have drunk this
Kool-Aid, but I've now seen somuch data on this and I have
seen so much of the patients andso many of the people
practicing this.
We do not use bariatric surgeryas a tool early enough or as
much as we should, and I knowthat there's a dip right now
happening because of Ozempic andall the other GLP-1 media and
(21:39):
stuff, in terms of how we usebariatric surgery, because
people are like, oh, I can justlose weight with a pill and not
have surgery.
We are not the same, and I wishthey were, because that'd be
cool, that'd be fun For sure.
If you could do this with apill, that would be amazing.
But we can't, and that's thekicker is that you have to take
pills forever.
Pills have side effects morethan surgery and they're
expensive and they're notcovered by a lot of insurance at
(22:00):
the moment.
So if you want to be beholdento those things for the rest of
your life with a medication,that's an option, and for some
people who can't qualify forsurgery or surgery is not safe
or whatever, that is an option,but for the majority of people
who have extra weight and it'sreally difficult for them to get
it off, especially if they haveissues like diabetes or high
blood pressure or infertility,or their sexual function is
(22:20):
impacted or other problems likearthritis.
Surgery should be consideredsooner, and if it were me, I
would In fact, when you'retalking about family members,
I'm not really at liberty to say, but that is a consideration,
and I have sent some of myclosest friends and people I
respect the most in my life forbariatric evaluations.
Speaker 1 (22:39):
Yeah, and I ask that because usually when you are at
the heart of things like that,what can go wrong, what the
complications or like long-termwhatever effects?
Just like a respiratorytherapist, I feel like a lot of
us are like do not intubate me,because I know what that looks
like.
So I just wanted to ask that Iknew what your answer would be,
(23:01):
or I thought I knew, but I justwanted to put that out there,
because there are a lot ofpeople out there that think, oh,
you just do this and yourecommend this because that's
your job, that's your career andyou make money off of it.
So that's why I asked that.
Speaker 2 (23:15):
Yeah, and to be honest with you, there's a lot
of ways to make money as asurgeon.
There's a lot of subspecialties,there's a lot of things, and if
you don't like this one you cango to another one, and I am
like trained in other ones aswell that I think are really
cool.
But this one, I think, is theone that makes such a big impact
.
And the thing is, I thinkpeople think latch on sometimes
to oh, it's surgery, it'sextreme, it has risks, you could
be hurt not doing somethingabout it, and a lot of people's
(23:37):
cases can hurt.
I have seen a lot of peoplelose toes to diabetes or lose
function, lose the ability tofeel comfortable, walking
through problems or not be ableto bear a child, or have really
crappy sex lives or just notlike how they look and not feel
comfortable to interact with theworld the way they want to.
I think those things are waymore devastating than the less
than 1% of people who have anykind of surgical complication.
(23:59):
So for me it is a totalno-brainer.
If this is an issue for me or afamily member, it is getting a
surgery evaluation.
Speaker 1 (24:07):
And I'm watching the time here.
So just like salute to me whenyou like are done.
This one, I know, can go down arabbit hole, so I want you to
give the least amount of time.
Oh sure, is obesity 100%preventable if you do all things
and you are all eating athousand calories or whatever?
Um, exercising 30 minutes, 60minutes a day, doing all the
(24:31):
things right, taking all yourvitamins, doing all the right
things, is it a hundred percentpreventable?
Speaker 2 (24:36):
No, no.
And let me explain why.
So it's preventable, in thesame way that, like, aging is
preventable or pregnancy, Iguess pregnancy is preventable,
but having a pregnancy and nothaving any impact on your body
is completely impossible.
Yeah, so no it.
Pregnancy is preventable, buthaving a pregnancy and not
having any impact on your bodyis completely impossible.
Yeah, so no, it is notpreventable.
First of all, there definitelyare factors of this that run in
families.
There are hereditary things thatbasically travel from a person
(24:56):
in their family line to them, intheir genes and above the gene
level too.
It's also humongously part ofour society If we were to change
all of the infrastructure ofour society, like how we eat and
how we get that food and whatthat food costs, and our work
lives and our school lives andoverall, just like education and
access.
We're completely different inour society than maybe fewer
(25:20):
people, but definitely noteverybody.
And then there's other thingsthat we don't even think about
sometimes, which is like priorattempts to lose weight.
So people who are at healthyweight and then diet, that
wrecks your metabolism long termfor pretty much everybody that
does it.
So even if you were at ahealthy weight but you try to
lose weight, to become skinnierat some point, or to lose weight
for an event or something likethat can have a lasting impact
(25:42):
on you and make it a lot harderfor you to either stay at a
healthy weight or lose to ahealthy weight in the future,
and the more times you do it,the more damaging it is.
Speaker 1 (25:51):
So that's what Dr Jessica Smith said is that how
many diets are women on by thetime they're 30?
Chances are it's probably adozen, where men they're like I
maybe stopped eating bread for aweek or something and I feel
like in my head that's why it'seasier for men to lose weight,
because they haven't done all ofthose diets usually and haven't
(26:12):
wrecked those metabolisms likeus women have.
It's just, I feel like Istarted dieting when I was
before my even teen years and atthat age most men aren't even
thinking about their weight.
They're barely thinking aboutyeah.
Speaker 2 (26:24):
About that.
I will say one.
There is a whole nother topic,I think, with men and weight and
men's bariatrics, because Iactually do think there's a lot
of disordered eating in men thatwe don't call it that and
dieting my husband eats once aday, usually Exactly, and maybe
that's by work, because of workor other reasons.
But there's actually quite a bitof disordered eating in men too
, and we definitely do need totalk about that.
And men do also have bodystandards that are unrealistic
(26:46):
that they're held to.
But here's the thing I thinkfor men at least, those body
standards are not.
You have to be the skinniest youcan possibly be and a stick in
order to be attractive, or justsome unreasonable like stick
plus boobs that we expect peopleto be, which is, again, like,
essentially nobody is thatwithout surgery, essentially,
unless you're extremely lucky insome genetic lottery, which
fewer than 1% of people are.
(27:07):
And then what was it?
Where was it going with this?
Yes, so the society standardsof especially women having to be
the skinniest they can possiblybe.
There's actually a lot of datathat shows that women are at
their most fertile, at theirmost healthy, at their best bone
density, all kinds of things ata BMI of 25 to 30.
So, and that's from a young ageon, through, especially,
(27:29):
menopause and after menopause.
So if we could convince womenthat the healthiest weight,
which is, you know, a BMI of 25to 30, is also the weight at
which they're the most beautiful, or they're the most, they're
going to be the best perceivedby society, or they're going to
be the most loved, or they'regoing to be the best perceived
by society, or they're going tobe the most loved, or they're
going to be the most respected,or they're going to be on
billboards or whatever it is,then maybe we would prevent more
(27:51):
people from dieting, andespecially dieting over and over
again to avoid getting out ofthat BMI of 25 to 30.
Because I do think a lot ofwomen do diet at a lower BMI
than men do or try to loseweight.
You see what I'm saying.
It's like men do it too, butthey might do it at a slightly
different range, and, for women,we're doing damage to our
bodies when we're in a healthyweight range.
(28:11):
That's the real kicker and,believe me, like I have had,
like I have binge eatingdisorder, I have struggled, as
myself, I'm at a BMI that isconsidered healthy, but in my
life I have probably been on adiet more than I haven't been,
and so it's 100% something thatI relate to and I really wish
that we were better at talkingabout and better at supporting
women and indicating to womenthat you are healthy and
(28:33):
beautiful as a result of thathealthiness and what your body
can do.
Speaker 1 (28:35):
That's why I love you .
You always hype me up so much.
I'm always like, and you'relike, you're beautiful, you're a
babe, and I'm like you are ababe.
Speaker 2 (28:43):
Oh my God, I saw your TikTok today.
I was like dang girl, you'relooking great, looking very fine
.
Speaker 1 (28:49):
Don't fight me about bariatric surgery being the easy
way out.
Speaker 2 (28:53):
All right.
Speaker 1 (28:53):
Before we go, do you have anything else to add?
Or question, or?
Speaker 2 (28:58):
Yeah, Again you're busy.
No, but I do want to ask you soin feeling, do you feel that
pressure now about your bodysize or about your weight, and
how do you deal with it if itdoes come up?
Speaker 1 (29:10):
I think my body size right now so I'm about 5'5 and
190 pounds, I'm not afraid towhatever it's and there's a lot
of loose skin, unfortunately.
I think where I'm at right nowis perfect for me.
I think it honestly is perfectfor a lot of women, Like that's
usually.
This is probably about I wasprobably 20 pounds less in high
(29:31):
school, but this is about whereI was at high school.
Now it just doesn't look asperky and stuff.
So I feel like I am not Jointhe club, Tammy.
I'm not ashamed of my size oranything.
I'm more ashamed of how I carryit now and that is just my own
mental barrier that I'm reallytrying to figure out how to
(29:53):
battle, because I guess I don'teven have that much loose skin.
I don't have.
I still have decent size breasts, but they just but this is just
me, this is not.
This is me wanting to look atmyself in the mirror and being
like, yes, girl, I would tellanybody else.
Yeah, you always tell me.
Would you say that to anybodyelse?
Speaker 2 (30:14):
No, that's why I'm like Tammy you are very
beautiful, you're really hot,you're also just really like
warm and engaging, and I dothink that part of our society
being so superficial about ourlooks that is especially
damaging to women is that wecannot be accepted for being
having an internal beauty andinternal ability, engagement
with the world that goes beyondour looks and I really think
(30:34):
that has impact on our health.
That has impact on our not justmental health but our physical
health a lot.
Speaker 1 (30:39):
It takes up mind way too much.
So that is something I'mworking on of.
So I do feel good about whereI'm at.
People could probably say I'mskinnier or could be skinnier,
but I am so happy where I'm at,I'm comfortable, I can outrun my
children.
I do struggle looking at myselfin the mirror, but that's
(31:00):
probably what has been drilledinto my head growing up is
skinny, big boobs, perky boobs,big butt.
Speaker 2 (31:07):
Yep, well, meh, yep, yeah.
On that lovely note, weobviously have some mental
health and other things to talkabout in future episodes, but
I'm really grateful to talk withyou today and it was wonderful
to see you in Cleveland.
We should do more of that.
Speaker 1 (31:19):
Yes, absolutely All right, I'll see you next time.
Thanks everybody.
Big hug, my love.
Goodbye, all right, we'll seeyou next time.
Thanks everybody.
Welcome to Core Bariatrics Podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Maria, you've been like MIA fora solid three months.
It is so hard to get time withyou.
I'm so happy to see your face.
Speaker 2 (00:35):
We just spent the whole weekend together pretty
much in Cleveland, which wasfantastic.
We were there for a conferenceand learned a ton about this
kind of surgery reflux surgery,all kinds of things.
It was a blast.
Speaker 1 (00:45):
Yeah, it was, so I should say yes, I have seen you,
just not on here, so it's likebrand new all over again.
That's right.
Speaker 2 (00:53):
And we've been working on a podcast.
We also created a chat GPT forour people called Berry Buddy,
which is like an AI assistantfor people who have gone through
bariatric surgery, and we'vetrialed it and tested it and
initially did not work, but nowit's working a little better.
Speaker 1 (01:09):
So, berrybuddy, try that out.
Yes, berrybuddy, chat GPT, yes,and it is nice.
I have gone on Facebook groupsfor bariatric surgery and
inputted questions off thatFacebook page into there and it
comes up with great answers.
So, instead of people usingthose Facebook groups as a quote
, unquote doctor, can I have anavocado one month post-op?
Everybody's going to have adifferent answer where this chat
(01:30):
GPT will give you a good, solidanswer that probably all
providers will agree with.
Speaker 2 (01:37):
Yeah, and we try to make it pretty generalized.
But it all comes fromguidelines and really good
research papers and our ownprogram materials and I spent
probably over a hundred hourstotal training this thing and
making sure it worked right andmaking sure it's not giving
people crazy answers.
That's not to say it's notperfect or that it is perfect.
It is not perfect.
However, it's probably a verygood general use tool so we can
(01:58):
create a, put a link up for that.
But if people want to give thata shot, definitely go for it.
It is free-ish Technically.
It's behind the paywall forchat GPT.
I can't change that at themoment.
Speaker 1 (02:09):
But as soon as I can, I promise you I will.
It's worth the $20 in myopinion, but that's just me.
Speaker 2 (02:15):
Yeah, that's true, and then money does not come to
us, it goes directly to OpenAI,so we don't make a single penny
from that at the moment.
Speaker 1 (02:25):
All right Throughout the past three months.
I keep coming up with questionsthat I want to ask you, and I
feel like our last question, orQ&A, went really well and it was
really informative.
Speaker 2 (02:31):
Yeah, where do you want to start?
And you can Q&A me too.
Speaker 1 (02:35):
whatever you want, oh yeah.
Speaker 2 (02:36):
Oh, 100% that's going to happen.
So actually let's go Q&A youfirst.
So you've been traveling somefor conferences.
We've gone to two so far thisyear and there's more coming up.
How do you deal with a changein your routine and stay on
track when you're traveling?
Speaker 1 (02:51):
Do the best I possibly can, I will say that
airports do have good, prettygood options.
You can almost always find somekind of grilled chicken.
Honestly, we found sushi, whichwas so good.
Yeah so good, there's watereverywhere, as long as you can
afford a $7 bottle of water, butthey have the water fountains.
So really just being in themindset of eating healthy,
(03:13):
keeping your fluids up, Becauseif you go sometimes this past
time I was flying I flew almosta half a day.
It was so bad.
It was like eight hours and soif I went that whole eight hours
without drinking anything, Iwould come home and feel like
I'm hungover.
So really being mindful andbeing strict with yourself of I
need to eat and I need to drink,but that's not to say you need
(03:35):
to be perfect.
I wasn't perfect, by any means,and I had a bag of combos
because, honestly, I needed acarb and I couldn't really find
any great carbs right in thatmoment.
So I had some combos.
Did I eat the whole bag?
No, but what?
Speaker 2 (03:52):
kind of quantity of combos did you have again?
Speaker 1 (03:54):
honestly, I would say a cup no, a bag you're done,
I'm sorry, I can't.
Speaker 2 (04:03):
We're both like we both and people from northern
iowa or parts of iowa just soundlike minnesotans and you're
from wisconsin, technically didI say it, did I say beg?
Of course you said big.
Speaker 1 (04:14):
Yes, you said big anyway, so I beg you to continue
no, but just making sure thatyou are eating and just because
you may not have the greatestoptions, to not eat, because
that's going to put you in awhole different world of hurt.
Speaker 2 (04:29):
That's very true.
Yeah, that's very true.
I love that because youbasically said be strict with
yourself, but strict where itcounts, if that makes sense,
because when you're travelingyour routine is going to be off
anyway.
I get super dehydrated when Itravel too, because you're just
more active.
Because you don't drink.
I also don't drink water, so,no, you got to drink.
But also be permissive withyourself.
If what?
(04:49):
If all the food around you isnot healthy, that doesn't mean
you don't eat, or that doesn'tmean you don't you don't take
some diets and take some things.
But yeah, you're right, I'vebeen impressed, actually, over
the past year.
I feel like a lot of optionseven in hotels have gotten
better.
They usually have some optionsdownstairs that you can grab,
and even options in coffee shopshave gotten better where you
can grab like a fruit bar ornuts or something like that.
(05:10):
So it really is getting better.
Speaker 1 (05:12):
But that doesn't mean that you just have to be a
saint and not partake when youyeah, especially when you travel
, because you have introduced meto so many foods that might not
be right in our bariatric bookof what I should eat, but I'm
going to eat it because I don'thave it all the time.
Speaker 2 (05:27):
Right and you're right, and we don't really talk
about how many things you caneat, and honestly, especially
from other cultures, because alot of other cultures have
totally different carbs andproteins and fats that they eat
and in different combinations,and sometimes it's healthier
than the standard American diet.
A lot of times it is.
Speaker 1 (05:49):
So getting creative and thinking outside the box
with what you're trying, that'ssuper, that's true, absolutely
Okay.
So I have a question for you,and I've had it come up when
during our program, but I'vealso actually seen it on their
Facebook pages, and it'ssomething that I think we can
talk almost more about later.
But a little quick how do youdo a colonoscopy prep when?
Speaker 2 (06:03):
you have bariatric surgery, cause you got to drink
all that in a short amount oftime.
Speaker 1 (06:08):
They're normal prep.
How do?
Speaker 2 (06:09):
you do that?
It's a great question.
Actually, I didn't.
We didn't have a standard wayof teaching patients how to do
this, and so we didn't have anymaterials in our program.
So when you brought this up acouple of months ago for our
chat GPT for Berry Buddy Iactually looked and I surveyed
some other surgeons that do thisand actually a lot of people
basically said no changes, whichI don't necessarily agree with
(06:31):
that, because I don't think thatyou can especially if you're
doing like a go lightly which isreally a go strongly but go
lightly prep like two gallons ofliquid that you're supposed to
do, and even if you're doing ina split fashion, where you're
doing like part of it one time,another part of another time,
you still probably shouldn't bedrinking more than about eight
ounces an hour, no matter what,as a bariatric patient.
Speaker 1 (06:52):
That just sounds painful Exactly.
Speaker 2 (06:55):
Think of when you were post-op and when you were
doing one ounce every 15 minutes.
You can probably do more thanan ounce every 15 minutes, but I
really wouldn't do more thanthree or four ounces every 15
minutes, because the other thingis all of that.
There it's more important toget the liquid in than how fast
you get it in.
In coming up with a combined, Ilooked at a lot of resources
(07:15):
for this and the consensus seemsto be start earlier and do the
best you can and do the best youcan.
Yeah, so over the two daysbefore your colonoscopy is when
I would recommend switching toliquids, as opposed to staying
on solids for the two days priorand then just being on liquids
the day before.
So I would do two days ofliquids and then start your prep
(07:36):
, whatever it may be.
Some places do Miralax,gatorade, some places still do
Golightly or Suprep or otherthings.
Just space it out over a day asopposed to over 12 hours, and
then really take thoserestrictions of liquids clear
liquids especially seriously,because your body's going to
have a little bit longer of atime processing things and a
little bit longer gettingthrough, and it's wiser for you
(07:58):
to start earlier.
Speaker 1 (07:59):
But this has me thinking of shouldn't there
almost be a separate type ofprep, because we don't eat as
much as most people do, so wedon't have as much to get
through our systems, right?
Speaker 2 (08:12):
I wouldn't say that's the case because a lot of why a
lot of people actually haveslower transit times after
surgery.
So some people definitelybecause of the malabsorption,
especially if you have a dutialswitch or bypass.
Sometimes your transit timesare faster, but sometimes
they're not.
So actually constipation is thebigger issue for people after
bariatric surgery, oftentimesagain because you're still
(08:33):
struggling with getting enoughfiber and getting enough liquids
in.
So transit times all in all areabout the same as they are
before surgery, just fordifferent reasons.
So my main takeaway here isplease start at least a day
earlier than you normally wouldwith your prep.
That's going to make sure thatyour chances of having to do it
all over again are less and thateverything's cleaned out, which
means that you get a real,really good colonoscopy.
(08:55):
And I do not recommend Cologuard, which is the test that you do
without the colonoscopy insteadof the right and like you can.
If you really just arecompletely grossed out by the
idea of a colonoscopy or justit's.
If the choice is no, nocolonoscopy at all or Cologuard,
then do Cologuard.
But even for my own family Ihave recommended against
Cologuard because it just doesnot detect as much early stage
(09:17):
colon cancer or pre-colon cancerrisk by any means as a real
colonoscopy does.
So I personally am not a hugefan of Cologuard.
For that reason, just throwingmy two cents in there.
Speaker 1 (09:27):
Absolutely.
Now, what do you think about apouch?
Quote unquote.
I am quote unquote, quotinghere a pouch reset.
I hear this all the time ofpatients like I'm doing poorly,
I'm gaining weight, and peopleare like, do a pouch reset, go
back to liquids and work yourway through the purees.
Yeah, what are?
(09:48):
Your thoughts on that.
Speaker 2 (09:49):
Yeah, so technically, yeah, technically we actually
had a whole panel on this atthis SAGES, the conference that
we went to over the weekend, andI was actually one of the
speakers on how to use your teamto combat weight regain after
surgery.
So this is a topic really nearand dear to me.
But the idea is there's no suchthing as a pouch reset per se.
Technically, if you've had asleeve some people do sleeve
(10:10):
resizing surgeries and if youhave had a gastric bypass which
does have a stomach pouch to it,there is a chance that the
pouch was made too big or thatthe opening between the stomach
and the small intestine hasbecome bigger over time.
That does happen.
We don't have a lot of evidencethat sleeves stretch out.
So if you started with a bigsleeve, if the surgery was done
(10:31):
in a way that it left a lot oftissue there, then you're going
to have a big sleeve and it'sprobably not going to work as
well as a smaller sleeve.
And it's the same thing with apouch.
If the pouch was big to beginwith, you're going to not have
as much malabsorption and asmuch metabolic change.
So your chances of weightregain down the road are higher
and your chances of not reallylosing the weight or having that
much change to your metabolismto begin with are higher too.
(10:52):
There are some surgeries thatcan be done to revise these
things.
That's typically not the firststep, though they're starting to
be right.
So, again, it's always a goodidea to reassess your lifestyle
in general.
Think that you're overeating.
If you think you're overeatingcertain things, if you think
you're not drinking enough, ifyou're thinking you're not
getting enough exercise youprobably aren't it's a good idea
(11:15):
to take a look at the thingsthat you can address and fix in
your lifestyle.
I will always say it's a goodidea to also think about your
mental health and make sure thatyou're not overstressed, that
you're in a good place, whetherthat means engaging with family,
friends or a professional orall of the above.
Those are good things to do.
Same thing with a dietician.
It's oftentimes helpful to havea third party take a look at
(11:35):
things, and not just yourfriends and family or yourself
when it comes to reality as towhat we're eating myself
included sometimes.
So that's a good idea.
Chatting with your bariatricprogram is a good idea if you're
having issues with weightregain, especially Some weight
regain is insignificant and itdoes mean something and some
doesn't.
So, we don't really treat all ofit the same way and it's not
(11:57):
like it's a straight shoot tosurgery for anyone, so that's a
meandering answer, but that'sbecause it's a meandering issue.
Speaker 1 (12:04):
Now you said reevaluate what you're eating.
So this kind of has a questionfor me how come I can only eat
six ounces of chicken breast?
But I could, if I wanted to andif I really felt like it, I
could almost eat a whole, half apizza.
I even told you the other daywhen we were eating sushi I'm
(12:24):
like wow, that little amount ofseaweed and California roll or
whatever we ate, filled me up somuch and it was such a little
amount of food.
But I technically, if I reallywanted to, could eat a whole lot
more in size of pizza.
Speaker 2 (12:38):
Oh, yeah, absolutely so.
There was actually one of thespeakers also at this conference
, when we were talking aboutweight regain, put up a couple
of charts that showed all of thedifferent hormones and all of
the different molecules that areinteracting in the body between
the stomach and the intestineand the brain and other body
parts, and there's like hundredsof them.
So I absolutely will not try torecreate this complex drawing
(12:59):
for anyone on a podcast.
That would be pretty ridiculous.
But the idea is that differentkinds of foods are processed
differently by our bodies, evenby the stomach as they hit the
stomach, even how our hunger andhow our desire for food, our
satiety when we feel full, isaffected by the food we eat and
if there's protein in it, ifthere's fiber in it, typically,
(13:21):
or even fat.
Actually, fat also typicallytriggers the feeling of fullness
faster than carbohydrates do.
And there's certain kinds ofcarbohydrates that trigger
faster than others, which is whyliquid calories typically, you
don't really feel full fromliquid calories, but you do feel
full from solid food, yeah, andso some of its physical, some
(13:45):
of its truly okay chicken kindof stays put more than like soda
or juice or something, or aprotein drink even, but if you
actually have certain proteins,and it's specifically some
proteins more than others, andsome kinds of fats more than
others, and insoluble fiber morethan soluble fiber, anyway, so
we can get into very specificthings in another episode, which
(14:07):
you probably should, but itabsolutely does matter what
you're eating, because you willfeel fuller faster if you're
eating things that have proteinand have fiber in them.
That does not mean, however,you should just be eating like
chopped chicken or something forthe rest of your life, and that
being the only thing, but thatis one reason why, when we talk
about eating snacks and food ingeneral, it's a good idea to eat
(14:27):
combinations of food ratherthan just one thing at a time.
Speaker 1 (14:32):
What if I came into your office and I said I don't
want to know what I weigh?
Yeah, I tell you all the timethat I'm honestly really not on
the scale a whole lot becauseand actually one of your panels
was talking about this andactually debating this BMI
target we should be at and oneof them was like I don't care
about a BMI target If my patientis a BMI of 38, let's say 40,
(14:57):
it feels fantastic.
I'm not going to choose thatBMI.
What if I came into your officeand, maria, I don't want to
know what I weigh?
Speaker 2 (15:06):
Yeah, absolutely.
We've actually had that Firstof all.
We've had that scenario.
So I can tell you 100% what Ihave done is said okay, no
problem, because I agree.
I think we have this obsessionwith BMI and weight in this
industry because it's the onething we can measure easily and
it's a vital technically, it's avital sign and, technically,
like we can measure it even athome with your weight, with your
scale and stuff, so pretty easyto measure.
(15:28):
That doesn't mean, it meansanything and I think that's
exactly what it was.
Actually Dr Teresa Lemasters,who's the recent president of
ASMBS, one of our bigorganizations and also just an
incredible powerhouse here inIowa, in Des Moines, who was
specifically talking about how,while BMI is an easy indicator
and it's something that we clingon to, it's not that useful and
probably in the next 10 yearsor so, there's even now a really
(15:51):
big push to move away from BMIand talk much more about
function, talk much more aboutwhat are our goals, what are our
metabolic issues that are goingon here.
Does this patient have diabetes?
Did their diabetes come back?
How bad is their diabetes?
What about their blood pressure?
What about other issues likefertility?
So I agree 100% that weighthere.
We oftentimes, and the problemis is, because it is a number
(16:13):
and because it is a, like, aneasy thing to measure, we not
just providers, not justsurgeons and coordinators and
stuff get get hung up on thissometimes, but it's used to
punish people.
I think sometimes to in thesense that with you, yeah, and I
think when we're talking again,like morality just doesn't have
any role in this field, orreally any healthcare field.
(16:34):
I think so when we're trying toprovide people care that
supports their goals and makespeople healthier, we should be
finding ways to enable that, notto make people feel bad about
it, and especially like you as aprovider, especially after
surgery, especially after thatlike one three month follow up.
Speaker 1 (16:51):
You only see six months and then you see a year.
Look, you don't know if, okay,I was 175 the last time but now
I'm 190.
But that might look different.
I might be way more in fit thannow because muscle does weigh
more than fat.
So how would you handle?
Because, as a provider,documenting, I think you do need
a weight.
And I think as a.
(17:12):
To be able to help your patient, you do need a weight.
How would you just ask themnicely to get on the scale but
turn around or like how?
Speaker 2 (17:21):
No, it depends.
It depends if actually we doneed that weight.
So different insurance policiesneed different things before
surgery, After surgery.
I don't really know of anyinsurance policy that requires
weight measurement becausenothing really depends on that,
so I don't.
The only consideration there iswhat is required by insurance.
And again, we use BMI and we useweight because it's easy to
(17:42):
bill for, it's easy to submit,requesting a prior authorization
or a billing code or somethinglike that.
Not because it's necessarilythe best measure of health.
Definitely it's not.
And it's not the best measureof success or goal achieving or
anything like that.
And I know personally Ifluctuate about 20, 30 pounds in
my life as an adult, andsometimes at my higher weight is
(18:04):
when I'm the most fit and at mylower weights is when I'm the
least fit.
And that extends massively toeveryone else on the planet too
and some of the some Olympiclevel athletes.
Actually there are quite a fewOlympic level athletes whose
BMIs are over 35.
So while they would qualify forbariatric surgery, that would
absolutely not be theappropriate choice for them, Nor
(18:26):
would any medical interventionbe appropriate for their weight
if they're achieving so muchfunctionally.
Yeah, I'm glad that there's areassessment of BMI and weight.
I don't think that's going tohappen overnight, so it depends
on what it's needed for.
If it's really neededdocumentation and we need to use
it to get to surgery, thenthat's a discussion, a
one-on-one discussion with aperson and to say, hey, we need
(18:46):
this for documentation and howimportant is it for you to get
to surgery?
Because we have to have it forgetting there.
But if it's not required andthe person doesn't want to do it
and it's not making adifference to their function,
then I agree.
Speaker 1 (19:04):
Yeah, absolutely.
So we talked about this onetime because we went and saw one
of our patients that just had abypass and I'm like she looks
like nothing even happened toher and I'm like I was over
there dying.
And you actually said bypassesare easier to heal from than
speeds.
Speaker 2 (19:17):
Yeah, okay.
So this is, I would say,immediate post-op.
It's not necessarily long-term,yeah, and it still depends on
how you do it.
But the thing is, when you'remaking a sleeve, what you're
doing is you're turning a bigreservoir, think a dam, like
before that wow, I'm really notan engineer, am I?
(19:39):
You're turning a lake, let's say, into a stream, and so the
effect of that is immediatelyonce you start drinking and
eating afterwards you reallyfeel the difference because you
still have a muscle right afteryour stomach called the pylorus,
that prevents things fromemptying or dumping into the
small intestine and moving on.
That is not there anymore aftera bypass.
(20:00):
That pylorus is bypassed partof the deep, the area that's not
part of the what's seeing foodor drink anymore.
So immediately afterwards youactually don't feel that kind of
resistance and that kind offullness and bloating that a lot
of people do feel after asleeve.
That's not to say that nobodyfeels that after a bypass, right
, certainly some people do, forthe the most part, but fewer,
(20:24):
and it's somewhat anecdotal, butactually there is some
literature on this too, thatit's actually easier to
discharge patients the day ofsurgery after a bypass, from a
symptom standpoint, or the nextday after a surgery that's a
bypass than it is after a sleeve, because about something like
80% of people who have a sleevestill will have some nausea into
post-op day one whereas thebypass is less than half.
(20:47):
So there's a big difference.
Yeah, based on that feeling ofoh, we've gone from a big space
to a little space that still hassome back pressure, versus in a
bypass, you're going from a bigspace to a little space, but
you don't have the back pressureanymore, because things are
immediately emptying from thestomach into the small intestine
.
Speaker 1 (21:02):
That makes sense.
Now, if you were, if youstruggled with weight or if
someone very close to youstruggled with weight, being a
bariatric surgeon, would youhave bariatric surgery or would
you recommend it to your family?
Speaker 2 (21:18):
Oh heck, yes, yeah, and I maybe have drunk this
Kool-Aid, but I've now seen somuch data on this and I have
seen so much of the patients andso many of the people
practicing this.
We do not use bariatric surgeryas a tool early enough or as
much as we should, and I knowthat there's a dip right now
happening because of Ozempic andall the other GLP-1 media and
(21:39):
stuff, in terms of how we usebariatric surgery, because
people are like, oh, I can justlose weight with a pill and not
have surgery.
We are not the same, and I wishthey were, because that'd be
cool, that'd be fun For sure.
If you could do this with apill, that would be amazing.
But we can't, and that's thekicker is that you have to take
pills forever.
Pills have side effects morethan surgery and they're
expensive and they're notcovered by a lot of insurance at
(22:00):
the moment.
So if you want to be beholdento those things for the rest of
your life with a medication,that's an option, and for some
people who can't qualify forsurgery or surgery is not safe
or whatever, that is an option,but for the majority of people
who have extra weight and it'sreally difficult for them to get
it off, especially if they haveissues like diabetes or high
blood pressure or infertility,or their sexual function is
(22:20):
impacted or other problems likearthritis.
Surgery should be consideredsooner, and if it were me, I
would In fact, when you'retalking about family members,
I'm not really at liberty to say, but that is a consideration,
and I have sent some of myclosest friends and people I
respect the most in my life forbariatric evaluations.
Speaker 1 (22:39):
Yeah, and I ask that because usually when you are at
the heart of things like that,what can go wrong, what the
complications or like long-termwhatever effects?
Just like a respiratorytherapist, I feel like a lot of
us are like do not intubate me,because I know what that looks
like.
So I just wanted to ask that Iknew what your answer would be,
(23:01):
or I thought I knew, but I justwanted to put that out there,
because there are a lot ofpeople out there that think, oh,
you just do this and yourecommend this because that's
your job, that's your career andyou make money off of it.
So that's why I asked that.
Speaker 2 (23:15):
Yeah, and to be honest with you, there's a lot
of ways to make money as asurgeon.
There's a lot of subspecialties,there's a lot of things, and if
you don't like this one you cango to another one, and I am
like trained in other ones aswell that I think are really
cool.
But this one, I think, is theone that makes such a big impact
.
And the thing is, I thinkpeople think latch on sometimes
to oh, it's surgery, it'sextreme, it has risks, you could
be hurt not doing somethingabout it, and a lot of people's
(23:37):
cases can hurt.
I have seen a lot of peoplelose toes to diabetes or lose
function, lose the ability tofeel comfortable, walking
through problems or not be ableto bear a child, or have really
crappy sex lives or just notlike how they look and not feel
comfortable to interact with theworld the way they want to.
I think those things are waymore devastating than the less
than 1% of people who have anykind of surgical complication.
(23:59):
So for me it is a totalno-brainer.
If this is an issue for me or afamily member, it is getting a
surgery evaluation.
Speaker 1 (24:07):
And I'm watching the time here.
So just like salute to me whenyou like are done.
This one, I know, can go down arabbit hole, so I want you to
give the least amount of time.
Oh sure, is obesity 100%preventable if you do all things
and you are all eating athousand calories or whatever?
Um, exercising 30 minutes, 60minutes a day, doing all the
(24:31):
things right, taking all yourvitamins, doing all the right
things, is it a hundred percentpreventable?
Speaker 2 (24:36):
No, no.
And let me explain why.
So it's preventable, in thesame way that, like, aging is
preventable or pregnancy, Iguess pregnancy is preventable,
but having a pregnancy and nothaving any impact on your body
is completely impossible.
Yeah, so no it.
Pregnancy is preventable, buthaving a pregnancy and not
having any impact on your bodyis completely impossible.
Yeah, so no, it is notpreventable.
First of all, there definitelyare factors of this that run in
families.
There are hereditary things thatbasically travel from a person
(24:56):
in their family line to them, intheir genes and above the gene
level too.
It's also humongously part ofour society If we were to change
all of the infrastructure ofour society, like how we eat and
how we get that food and whatthat food costs, and our work
lives and our school lives andoverall, just like education and
access.
We're completely different inour society than maybe fewer
(25:20):
people, but definitely noteverybody.
And then there's other thingsthat we don't even think about
sometimes, which is like priorattempts to lose weight.
So people who are at healthyweight and then diet, that
wrecks your metabolism long termfor pretty much everybody that
does it.
So even if you were at ahealthy weight but you try to
lose weight, to become skinnierat some point, or to lose weight
for an event or something likethat can have a lasting impact
(25:42):
on you and make it a lot harderfor you to either stay at a
healthy weight or lose to ahealthy weight in the future,
and the more times you do it,the more damaging it is.
Speaker 1 (25:51):
So that's what Dr Jessica Smith said is that how
many diets are women on by thetime they're 30?
Chances are it's probably adozen, where men they're like I
maybe stopped eating bread for aweek or something and I feel
like in my head that's why it'seasier for men to lose weight,
because they haven't done all ofthose diets usually and haven't
(26:12):
wrecked those metabolisms likeus women have.
It's just, I feel like Istarted dieting when I was
before my even teen years and atthat age most men aren't even
thinking about their weight.
They're barely thinking aboutyeah.
Speaker 2 (26:24):
About that.
I will say one.
There is a whole nother topic,I think, with men and weight and
men's bariatrics, because Iactually do think there's a lot
of disordered eating in men thatwe don't call it that and
dieting my husband eats once aday, usually Exactly, and maybe
that's by work, because of workor other reasons.
But there's actually quite a bitof disordered eating in men too
, and we definitely do need totalk about that.
And men do also have bodystandards that are unrealistic
(26:46):
that they're held to.
But here's the thing I thinkfor men at least, those body
standards are not.
You have to be the skinniest youcan possibly be and a stick in
order to be attractive, or justsome unreasonable like stick
plus boobs that we expect peopleto be, which is, again, like,
essentially nobody is thatwithout surgery, essentially,
unless you're extremely lucky insome genetic lottery, which
fewer than 1% of people are.
(27:07):
And then what was it?
Where was it going with this?
Yes, so the society standardsof especially women having to be
the skinniest they can possiblybe.
There's actually a lot of datathat shows that women are at
their most fertile, at theirmost healthy, at their best bone
density, all kinds of things ata BMI of 25 to 30.
So, and that's from a young ageon, through, especially,
(27:29):
menopause and after menopause.
So if we could convince womenthat the healthiest weight,
which is, you know, a BMI of 25to 30, is also the weight at
which they're the most beautiful, or they're the most, they're
going to be the best perceivedby society, or they're going to
be the most loved, or they'regoing to be the best perceived
by society, or they're going tobe the most loved, or they're
going to be the most respected,or they're going to be on
billboards or whatever it is,then maybe we would prevent more
(27:51):
people from dieting, andespecially dieting over and over
again to avoid getting out ofthat BMI of 25 to 30.
Because I do think a lot ofwomen do diet at a lower BMI
than men do or try to loseweight.
You see what I'm saying.
It's like men do it too, butthey might do it at a slightly
different range, and, for women,we're doing damage to our
bodies when we're in a healthyweight range.
(28:11):
That's the real kicker and,believe me, like I have had,
like I have binge eatingdisorder, I have struggled, as
myself, I'm at a BMI that isconsidered healthy, but in my
life I have probably been on adiet more than I haven't been,
and so it's 100% something thatI relate to and I really wish
that we were better at talkingabout and better at supporting
women and indicating to womenthat you are healthy and
(28:33):
beautiful as a result of thathealthiness and what your body
can do.
Speaker 1 (28:35):
That's why I love you .
You always hype me up so much.
I'm always like, and you'relike, you're beautiful, you're a
babe, and I'm like you are ababe.
Speaker 2 (28:43):
Oh my God, I saw your TikTok today.
I was like dang girl, you'relooking great, looking very fine
.
Speaker 1 (28:49):
Don't fight me about bariatric surgery being the easy
way out.
Speaker 2 (28:53):
All right.
Speaker 1 (28:53):
Before we go, do you have anything else to add?
Or question, or?
Speaker 2 (28:58):
Yeah, Again you're busy.
No, but I do want to ask you soin feeling, do you feel that
pressure now about your bodysize or about your weight, and
how do you deal with it if itdoes come up?
Speaker 1 (29:10):
I think my body size right now so I'm about 5'5 and
190 pounds, I'm not afraid towhatever it's and there's a lot
of loose skin, unfortunately.
I think where I'm at right nowis perfect for me.
I think it honestly is perfectfor a lot of women, Like that's
usually.
This is probably about I wasprobably 20 pounds less in high
(29:31):
school, but this is about whereI was at high school.
Now it just doesn't look asperky and stuff.
So I feel like I am not Jointhe club, Tammy.
I'm not ashamed of my size oranything.
I'm more ashamed of how I carryit now and that is just my own
mental barrier that I'm reallytrying to figure out how to
(29:53):
battle, because I guess I don'teven have that much loose skin.
I don't have.
I still have decent size breasts, but they just but this is just
me, this is not.
This is me wanting to look atmyself in the mirror and being
like, yes, girl, I would tellanybody else.
Yeah, you always tell me.
Would you say that to anybodyelse?
Speaker 2 (30:14):
No, that's why I'm like Tammy you are very
beautiful, you're really hot,you're also just really like
warm and engaging, and I dothink that part of our society
being so superficial about ourlooks that is especially
damaging to women is that wecannot be accepted for being
having an internal beauty andinternal ability, engagement
with the world that goes beyondour looks and I really think
(30:34):
that has impact on our health.
That has impact on our not justmental health but our physical
health a lot.
Speaker 1 (30:39):
It takes up mind way too much.
So that is something I'mworking on of.
So I do feel good about whereI'm at.
People could probably say I'mskinnier or could be skinnier,
but I am so happy where I'm at,I'm comfortable, I can outrun my
children.
I do struggle looking at myselfin the mirror, but that's
(31:00):
probably what has been drilledinto my head growing up is
skinny, big boobs, perky boobs,big butt.
Speaker 2 (31:07):
Yep, well, meh, yep, yeah.
On that lovely note, weobviously have some mental
health and other things to talkabout in future episodes, but
I'm really grateful to talk withyou today and it was wonderful
to see you in Cleveland.
We should do more of that.
Speaker 1 (31:19):
Yes, absolutely All right, I'll see you next time.
Thanks everybody.
Big hug, my love.
Goodbye, all right, we'll seeyou next time.
Thanks everybody.
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